Otolaryngology Coding Alert

Remember to look for – and code – additional conditions. 

If you come across notes from the otolaryngologist about “lymphadenopathy,” it means the patient has an abnormal enlargement of lymph nodes. Diagnosis coding under ICD-9 points you to 785.6 (Enlargement of lymph nodes). The code also applies to the term “swollen glands,” and excludes lymphadenitis.

ICD-10 changes: When ICD-10 takes effect on Oct. 1, 2015, you’ll shift to code R59.9 (Enlarged lymph nodes, unspecified) when reporting lymphadenopathy. Only the word “unspecified” in R59.9’s descriptor differentiates this ICD-10 code from ICD-9.

Documentation: During the physical exam, your physician will evaluate and note the size, location, and character of lymphadenopathy as well as other physical findings that could suggest more serious lymphadenopathy (such as fever, anorexia, aches and pains, weight loss, and night sweats). 

Some of the causes of lymphadenopathy are obvious, as with the patient who presents with a sore throat, tender lymph nodes in the neck area (cervical nodes), and a positive strep test. In other cases, they are not clear.

Coding tip: The lymph nodes are found in the underarm, groin, neck, chest, and abdomen, and act as filters for the lymph fluid as it circulates through the body. Since lymphadenopathy is a sign of an underlying disease, make sure you use the patient’s history, symptoms, and physical examination to determine the source of infection, thus the appropriate diagnosis code.